This study will provide a reliable description of national patterns of exit and reentry into nursing homes by the elderly over a five year period. Such a description will fill a gap in existing knowledge about the natural history of nursing home utilization. This study will clarify the relationship between separate nursing how stays and episodes of nursing home care, focusing particularly on patterns of multiple admission. Data from the 1985 National Nursing Home Survey and its three follow-up waves in 1987, 1988 and 1990 will be used to examine patterns and predictors of multiple admission in a cohort if elderly people admitted to a nursing home for the first time in 1984-85. A conceptual distinction between three types of multiple admission will be used. Readmission is defined to mean two separate nursing home stays separated by a period of residence in the community. Transfer is defined as two nursing home stays without any intervening interval. Interruption of Stay involves two nursing home stays separated by an interval of acute hospital care. These definitions will help clarify ambiguity in defining nursing home stays which have led to bias in estimates of length of stay and lifetime of nursing home stays. The analytic plan will encompass descriptive analysis of the natural history of patterns of multiple admission, multivariate modeling of predictors of read admission, and survival analysis of time until multiple admission occurs. The importance of factors such as graphic characteristics, physical health, functional deficits, mental morbidity, social support, nursing home characteristics, and health service history will be examined for impact on risk of readmission. Unlike extant research, the results of this study will be generalizable to the U.S. nursing home population over 65 years old. The information on the rate of occurrence multiple admission and the associated length of stay of episodes of care will be useful in developing more accurate cost and utilization projections of nursing home care. In addition, understanding the risk factors associated with multiple admissions may suggest interventions to reduce unnecessary nursing home use.